Provider Demographics
NPI:1265946537
Name:BASTAR, SHAHLA (DACM, MAOM)
Entity type:Individual
Prefix:
First Name:SHAHLA
Middle Name:
Last Name:BASTAR
Suffix:
Gender:F
Credentials:DACM, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINTHROP ST STE 316W
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4435
Mailing Address - Country:US
Mailing Address - Phone:617-959-0110
Mailing Address - Fax:617-404-9405
Practice Address - Street 1:10 WINTHROP ST STE 316W
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4435
Practice Address - Country:US
Practice Address - Phone:617-959-0110
Practice Address - Fax:617-404-9405
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist